Paul H. Byerly
Inhibited ejaculation is essentially the opposite of premature ejaculation – ejaculation takes a long time or does not happen at all. If a man can ejaculate after prolonged stimulation he suffers from retarded ejaculation, if he cannot ejaculate at all he suffers from anejaculation. Usually the man can ejaculate normally in some situations (solo masturbation, or manual or oral sex with his wife) but not in others (usually intercourse).
Delayed ejaculation is a difficult and frustrating problem. Some couples ignore it until they want to get pregnant. Some men deal with it by refusing sex, leaving their wife wondering what she has done wrong. Some men fake orgasm during intercourse and finish later on their own (not difficult if they use condoms) leaving the wife unaware of the problem. Regardless of how it plays out, it harms the couple’s sex life and if not treated will likely harm their marriage.
Once thought to be rare, recent studies have found that from 5% to 8% of men experience some level of inhibited ejaculation for at least one month of the last year, with about 3% having experienced it for at least six months over the past year1. These numbers are now on the rise due to the use of Internet porn, which can result in a man being unable to reach climax without porn.
As a strict/religious upbringing is common in men who suffer from inhibited ejaculation, we expect the occurrence in our audience is higher than the general population. It is our hope that some of the other pages on this site will help with that by showing that God created sex, and intended it to be a source of pleasure and connection in marriage. The condition is more common among those with a driving personality, and often those who suffer from this are very successful in business.
There are five categories of causes for inhibited ejaculation: physical damage, drug induced, porn related, physiological, and idiosyncratic conditioning. When a man who has previously not had a problem begins to experience inhibited ejaculation, drugs, porn, or physical causes are usually the culprit. If the man has the difficulty from his earliest attempts at sex with a woman, then psychological issues are most likely the cause.
Porn Related: While this effect has long been claimed as a possible side effect of porn use, it has not been seen until recently. In the last couple of years a growing number of doctors and counsellors are seeing men who have used so much Internet porn that they find it difficult or impossible to climax while not viewing porn. Initial claims of this condition were met with scepticism, but the sheer number of men reporting this has changed many experts’ minds. The theory is that this is happening now because Internet porn is available in quantity and variety never before possible. Heavy use causes a man to need new images to become fully aroused, resulting in the inability to climax or even get and maintain a usable erection with a real woman. It is likely that will soon become the most common cause of inhibited ejaculation. (See Porn-Induced Sexual Dysfunction Is a Growing Problem for more on this.)
Psychological: Traditionally this has been the most common cause. Guilt, or thinking that sex is dirty or shameful, can interfere with a man ejaculating, especially with a woman. Wrong religious teaching and anti-sex parents are a common root problem. Traumatic events, such as an unplanned pregnancy, or being caught during sex or masturbation can also be an issue. Fear of pregnancy, STDs or “being caught” can also cause inhibited ejaculation. A man’s anger or frustration with his wife can be an issue, as can withdrawal or a desire to manipulate or control.
Physical: Neurological diseases such as strokes and nerve damage to the spinal cord or back can impair ejaculation. Diabetic neuropathy, spinal cord lesions, and multiple scleroses can also cause this problem. Age related loss of penile sensitivity and firmness of erection may cause ejaculatory problems for some men. Incidence of delayed ejaculation was slightly greater in men over 40 in one study2, but the difference was not significant.
Drug Induced: Many drugs can interfere with normal sexual function. Selective serotonin reuptake inhibitors (SSRIs) are infamous for this, with drugs like paroxetine (Paxil®), fluoxetine (Prozac®), sertraline (Zoloft®), and thioridazine (Mellaril®) being among the most common to cause problems. Alpha blockers, antipsychotics such as thioridazine (Mellaril®) and antihypertensives such as guanethidine (Ismelin®) are also known to cause problems for some men. Consuming large amounts of alcohol can cause problems with ejaculation. Normally this is short term, but regular heavy drinking may result in a more permanent condition.
Idiosyncratic Conditioning: If a man learns to reach climax using a method that produces stimulation very unlike the stimulation of intercourse, he may have difficulty finding intercourse stimulating enough to ejaculate. Unusual methods of masturbation (such as using a shower head or striking the penis against a solid object) are the most common, but having sex by “dry humping” through clothes or being manually brought to orgasm though clothes can also do it. While there are documented cases of this, it is rare and usually easily resolved.
Professional treatment usually requires a minimum of a dozen treatments over many months. Treatment success rates of 42% to 82% were found in one meta-analysis 3. Successful treatment requires the couple be dedicated to resolving the problem, and willing to commit to long-term treatment.
First, the cause must be discovered, as treatment varies depending on cause. If the man can ejaculate normally from a few minutes of solo masturbation (by hand and without porn), the cause is almost certainly psychological. A man taking any prescription medication should ask his doctor if ejaculatory problems are a known side effect. Some drugs take time to build up in the body, with the affect becoming apparent only slowly, so there could be a significant lag between starting a drug and it affecting ejaculation. Idiosyncratic conditioning is easy to rule in or out – either the man has done something that could cause this or not. Porn will be obvious to the man, but may not be to his wife. If inhibited ejaculation occurs in a man who has been experiencing normal ejaculation, a physical is in order. Physical causes can have life harming affects, and discovery and treatment of such conditions is vital.
Porn Related: The solution is to end all use of porn. It will take a few weeks to a few months to “reset” the mind so that normal sex becomes possible. The man may suffer arousal with difficulty or inability to have a climax during the recovery time, but giving in and using porn will only prolong the problem.
Physical Causes: Obviously, a doctor must deal with such issues. In addition to treating the cause, there may be drugs that can help. In difficult cases, a specialized vibrator designed for this purpose may help the man who cannot ejaculate any other way.
Drug Induced: First, the warning – do not ever change dosage or stop taking a drug without a doctor’s authorization. It’s sometimes possible to change prescriptions and eliminate the ejaculatory difficulty without losing the needed drug benefit. It may also be possible to use a lower dose, or to take doctor regulated “drug holidays” that allow normal sexual function without lowering drug levels enough to lose the beneficial effects. It may also be possible to add another drug, which counteracts the ejaculatory side effect of the original drug. Since drugs affect each man differently , there is a lot of trial and error required; don’t give up!
Idiosyncratic Conditioning: The solution here is to gradually modify the form of stimulation that does work. For example, if a man has become conditioned to ejaculate during clothed sex, the couple first removes his pants and proceeds as before. When this is working well, her pants come off. Step by step the move to both being naked, with him climaxing by rubbing against her vulva. Next, they could add some lubrication as they do this. Gradually they work up to external rubbing and switching to intercourse at “the last moment”, or have intercourse with him switching to external rubbing for climax. A similar gradual change would be used for a man who has been conditioned by an unusual form of masturbation. Initially the wife is just present, and then she gradually takes over doing it the way the man does it. Slowly she modifies what she does to move towards a “pumping” with her lubricated hand.
Psychological Causes: This is often the most difficult one. Success depends on how long the problem has gone on, how serious the man and his wife are about fixing it, and the health of the marriage relationship in general. Dealing with the root causes may help, particularly if shame, guilt, or anger are present, but sometimes this is a dead end. Re-conditioning through small steps is usually the primary factor in curing the problem. What follows is a suggestion for doing it yourself. While this will work for some, it won’t work for most and there is the risk it will result in discouragement that will make treatment more difficult. Working with a professional is preferred, and if you work at this for a couple of months and have no success please find a professional.
Some block in the man’s mind prohibits him from ejaculating, or from ejaculating without prolonged stimulation, in certain situations. The man may be fine in every act other than intercourse, he may be unable to masturbate to climax in his wife’s presence, or he could be somewhere between these two extremes.
One of the problems with psychological inhibited ejaculation is “over thinking.” The man is too concerned about if he will climax, how close he is, how long they have been doing it, and so on. This interferes with the natural process that leads to climax, so distracting the man from such thinking can help a great deal. Focusing on his wife, focusing on the sensations in his sex organs, having a sexual fantasy about his wife, or listening to her describe a sexual fantasy about them can all help. Even something as mundane and non-sexual as math problems may help, but a sexual distraction is far better.
It is necessary to make dealing with the problem a priority, and working on it regularly is critical. Daily will put too much “pressure” on most men; setting aside three or four times a week is good. The chosen time needs to be when both husband and wife will be fully awake and as relaxed as possible; last thing at night or right after work are not good choices. Complete privacy and lack of distractions is important. Turn off phones, and if there is anyone else in the house get a lock for the bedroom door.
Some men unwillingly sabotage themselves by engaging in solo masturbation. A build up of sexual tension is a good thing in trying to overcome ejaculation problems, so don’t drain it away. The man must agree to not masturbate other than during the prescribed times. Once he can climax with his wife in the room, solo masturbation shouldn’t happen at all. In addition, once she can bring him to orgasm, all masturbation (by his hand) must stop.
The outline below is for a man who can’t masturbate to climax with his wife in the room – find the place where you have trouble and start there. You may be able to skip some steps, but if your first try after skipping a step fails, go back to the one you skipped. Don’t move to the next step as soon as you accomplish the one before it; do it until it’s fairly easy. Some steps may be easy the first time, others will take many tries. If you are unable to climax at a new step, go back to the last step. If you get to a step where you cannot climax, you might try it a couple of times in a row a few hours apart without doing anything else to climax. The build-up of arousal and need to ejaculate are your friends here.
Initially the man tells his wife he is going to go masturbate, then goes to the bedroom to do so while his wife stays in another room.
Next, the man masturbates while his wife is just outside the closed door.
The door is open, with the wife sitting where she cannot see her husband as he masturbates.
The wife is in the bedroom, but the room is dark and she is sitting in a chair facing away from the bed.
She joins him on the bed, lying so she is not touching him. Initially the room is dark, but on subsequent tries the room is dimly lighted (candle or bathroom light on with door open a crack). If this is too difficult, she can move back to the chair, but with so light and watching him.
The wife sits next to him on the bed, clearly watching him masturbate in good light.
She touches him non-sexually as he masturbates. Her leg against his body, her hand on his arm, and so on. Initially the touch is not moving, once he can climax this way she can stroke him.
If the man normally masturbates dry, now is a good time to add a lubricant. If he loses the ability to climax at this point, they back up and do some of the proceeding steps with lubricant. From here on lubricant should be used.
She begins to touch his genitals as he masturbates. She does this in a way that does not significantly interfere with his normal movements. Initially she may need to stop when he wants to climax.
He teaches her how to stimulate him by “hand riding.” She places her hand over his, finger for finger, and moves with him as he masturbates. Then she stimulates him as she has seen him do, with his hand rides hers. In this second step, the man is teaching her how firmly to hold his penis, and how quickly to move.
Now intercourse begins. Initially she is on top – he is passive, just receiving. Following some manual stimulation, intercourse occurs for a short time, and is followed by her bringing him to climax by hand. The wife is in control here, she moves from manual to intercourse and back to manual as she feels is best; she should not extend intercourse because he indicates he is “very close,” as this can lead to frustration and relapse if he does not quickly climax.
She increases the amount of manual stimulation before intercourse, working up to his being on the verge of climax before intercourse.
A reduction of light or total lack of light may help at this point. It may also be advisable to cut back to fewer attempts a week, as more frequent ejaculations may take away too much of his drive for orgasm.
If he remains unable to climax during intercourse, try Pseudocourse, which uses the vulva rather than the vagina for stimulation.
It should be understood that a single climax during intercourse does not mean the problem is forever gone: a single “success” could be followed by one or more attempts when the man cannot ejaculate in the vagina. Continue the same technique until orgasm during intercourse occurs every time.
Begin to make changes: reduce the amount of stimulation prior to intercourse starting, or change position. The wife should remain “in control” as this happens, and if she feels intercourse is going too long she needs to stop him and finish him by hand.
If the couple gets stuck, a vibrator might help. The vibrators sold as sex toys are usually too weak – a vibrator made for sore muscles is stronger and more likely to work. Be careful, and have the man determine how the vibrator should be used.
The wife is going to get aroused during many of these steps. Her needs are important, but must be met in a way that does not interfere with his progress. If watching her masturbate arouses him, having her do that before, or while he masturbates, will help him. If her nudity arouses him without making him feel pressured, that is helpful. If him giving her a climax before his makes it easier for him, they should do that. For some men it will be better for him to take care of her after he is done, or to lie with her as she does it. Once he has beat the issue, her needs and desires will become more important, but during treatment, she needs to give do what works best for him.
If the above does not show any sign of working in 6 to 8 weeks, please find a counsellor or physiologist who has experience working with inhibited ejaculation. The longer it’s left untreated, the more difficult it is to resolve.
As frustrating as this condition is, it can be treated. Don’t let fear or embarrassment keep you from getting help, and learning to enjoy sex as God intended.
1 Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999;281:537–544
Mercer CH, Fenton KA, Johnson AM, et al. Sexual function problems and health seeking behaviour in Britain: probability sample survey. BMJ 2003;327:426–7
2 Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999;281:537–544
3 Munjack DJ, Kanno PH. Retarded ejaculation: a review. Arch Sexual Behav 1979;8:139–5
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